Gary Lakin Regional Director HIMSS Analytics Asia Pacific (Friday, 7.15am, Forum Room)

1. HIMSS ANALYTICS ASIA PACIFIC
Electronic Medical Record Adoption Model™
(EMRAM)
Gary Lakin
Regional Director
HIMSS Analytics Asia Pacific
PREPARED BY

2. Agenda
 Who is HIMSS Analytics?
 What is the EMR Adoption ModelSM (EMRAM)
 How is the Model used?
 How does New Zealand score?
 Where do we go from here?
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3. About HIMSS Analytics
 Formed in 2004 as the research arm of HIMSS
 HIMSS Analytics Asia Pacific established in 2011
 30 years of data collection and reporting
 Collect and analyse data related to the use of information
technology in the healthcare industry
 Track technology implementations, trends, and identify
opportunities for advancing and improving the quality, safety and
efficiency of care
 www.himssanalyticsasia.org and www.himssanalytics.org
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4. THE EMR ADOPTION MODEL
(EMRAM)
A common understanding drives improved outcomes

5. Introduction to the EMRAM
 Acute Care Model created in 2005 for the North
American market and then localized for both the Europe
and Asia Pacific regions
 Creates a common framework and foundation for a
dialog around IT adoption
 Intended to push the industry to increasingly
sophisticated levels of IT adoption.
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6. EMRAM Study
Benchmarking drives Performance Improvement
 Objective – to track and evaluate IT system utilization in relation to its
impact on improved patient care and operational efficiencies within the
acute care setting.
 EMRAM Score provides a roadmap for implementing technologies that
enable a fully realized EMR that improves patient care.
 Gap Assessment allows hospitals to determine “what’s next”.
 Segment Comparison Reports compares EMR-readiness within
geographical segments of interests.
 Benchmarking Tools - over 40 peer comparison reports provide
intelligence for future planning and operational advancements.
 Custom Reporting for Government and Regional Organisations.
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7. EMRAM Explained
 An EMR is an environment not one specific system
 8 Stages (0-7) of increasingly sophisticated levels of adoption
 Drives improved outcomes through advanced clinical decision support
 To progress from one stage of adoption to another a hospital must have all
technologies in a specific stage implemented in at least one acute care
setting (thru Stage 6)
 An EMRAM Score has four decimal places
 Technologies implemented in higher level stages not yet achieved are
reflected by the values following the decimal place
 EMRAM scores are confidential – De-identified in peer level
benchmarking and analysed at an aggregate level
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8. 8

9. HOW IS THE MODEL USED?
Know What’s Next

10. How is the EMRAM Used?
 Healthcare Providers
• Benchmark IT efforts
• Identifying opportunity for cost and resource efficiencies
• Guidance for IT strategic planning
• Justification for Investment
 Vendors
• Promote client successes
• Partner with clients
 Thought Leadership
• Predict market trends
• Inform government policy decisions
• Identify intentional/unintentional consequences of EMRs
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11. An Example: EMR Adoption in the U.S. Market
Trended 2006 – 2011 (% of U.S. Hospitals)
Stage 2006 2007 2008 2009 2010 2011
Stage 7 0.0% 0.0% 0.3% 0.7% 1.0% 1.2%
Stage 6 0.1% 0.8% 0.5% 1.6% 3.2% 5.2%
Stage 5 0.5% 1.4% 2.5% 3.8% 4.5% 8.4%
Stage 4 3.1% 2.2% 2.5% 7.4% 10.5% 13.2%
Stage 3 18.7% 25.1% 35.7% 50.9% 49.0% 44.9%
Stage 2 40.0% 37.2% 31.4% 16.9% 14.6% 12.4%
Stage 1 17.4% 14.0% 11.5% 7.2% 7.1% 5.7%
Stage 0 20.4% 19.3% 15.6% 11.5% 10.1% 9.0%
Number of
Hospitals n = 4,237 n = 5,073 n = 5,166 n = 5,235 n = 5,281 n = 5,337
Tracking EMR adoption assists in the creation of policies and
strategies that drive EMR adoption and improved patient care
Source: HIMSS Analytics ® Database 11

12. EMR Adoption Comparisons Across Regions
EMRAM United
Stage States Canada Germany Italy Spain Sweden UAE Singapore
7 1.20% 0.00% 0.87% 0.00% 0.00% 0.00% 0.00% 0.00%
6 5.20% 0.50% 0.00% 1.35% 4.59% 2.94% 0.00% 66.67%
5 8.40% 0.20% 11.30% 2.70% 32.11% 26.47% 16.67% 0.00%
4 13.20% 2.30% 6.96% 5.41% 14.68% 2.94% 2.78% 0.00%
3 44.90% 36.50% 7.83% 8.56% 6.42% 11.76% 2.78% 0.00%
2 12.40% 20.4% 12.17% 15.77% 12.84% 35.29% 33.33% 33.33%
1 5.70% 14.50% 1.74% 30.18% 9.17% 0.00% 30.56% 0.00%
0 9.00% 25.60% 59.13% 36.04% 20.18% 20.59% 13.89% 0.00%
No. of
Hospitals 5337 641 115 222 109 34 36 6 12

13. Trends: EMR Adoption Positively Associated to
Operating Margin
Source: HIMSS Analytics ® Database 13

14. EMR ADOPTION IN
NEW ZEALAND
Identifying opportunity for improved outcomes

15. Sample Scores for 4 New Zealand Hospitals
Source: HIMSS Analytics ® Database 15

16. Mean and Median EMRAM Scores Across
Countries
* Not statistically significant
Source: HIMSS Analytics ® Database
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17. GETTING TO STAGE 6
Strategic planning

18. Sample EMR Gap Assessment*
Identifying Opportunities for a Fully Realized EMR
Hospital A Hospital B Hospital C Hospital D
Stage (2.2690) (2.2100) (2.1990) (2.1390)
1 Completed Completed Completed Completed
2 Completed Completed Completed Completed
Electronic Medication Electronic Medication Electronic Medication
Electronic Medication
3 Administration Record (EMAR)
Administration Record (EMAR), Administration Record (EMAR), Administration Record (EMAR),
Nursing Documentation, Order Entry Order Entry Nursing Documentation
Computerized Practitioner Order Computerized Practitioner Order Computerized Practitioner Order Computerized Practitioner Order
Entry (CPOE), Physician Type Use Entry (CPOE), Physician Type Use Entry (CPOE), Physician Type Use Entry (CPOE), Physician Type Use
4 CPOE, Physicians Use CPOE - CPOE, Physicians Use CPOE - CPOE, Physicians Use CPOE - CPOE, Physicians Use CPOE -
Medical Orders Medical Orders Medical Orders Medical Orders
PACS Radiology - DF (Digital
5 Completed Completed Fluoroscopy), PACS Radiology - Completed
Nuclear Medicine,
Closed Loop, Electronic Medication
Closed Loop, Electronic Medication Closed Loop, Electronic Medication Closed Loop, Electronic Medication
Administration Record (EMAR),
Administration Record (EMAR), Administration Record (EMAR), Administration Record (EMAR),
Medication Administration Bar-
Medication Administration Bar- Medication Administration Bar- Medication Administration Bar-
6 coding, Patient And Medication Bar- coding, Patient And Medication Bar- coding, Patient And Medication Bar-
coding, Patient And Medication Bar-
coded or RFID, Physician
coded or RFID, Physician coded or RFID, Physician coded or RFID, Pharmacy Bar-
Documentation, Track Inventory
Documentation Documentation coding, Physician Documentation
Management in Pharmacy
7 Not Validated Not Validated Not Validated Not Validated
*Detailed Gap Assessment provided in Excel format
Source: HIMSS Analytics ® Database 18

19. Identifying Investment Opportunity
 The four sample hospitals have achieved Stage 2
 There are three major gaps in technology needed to achieve Stage 6
1. Documentation
• Stage 3 - For Nurses at 2 hospitals
• Stage 3 - For medication -- Electronic Medication Administration
Record (EMAR) at all hospitals
• Stage 6 - For Physicians with structured templates at all 4 hospitals
1. CPOE with physician adoption (Stage 4)
2. Closed Loop Medication Administration (Stages 6)
Source: HIMSS Analytics ® Database 19

20. WHERE DO WE GO FROM
HERE?
100% hospital engagement

21. Facilities
Region District Health Board Facilities Completed
Participation to Date Northland 4 0
Auckland 1 1
Northern
Waitemata 2 2
• 3 of 4 Regions Counties Manukau 1 0
• 8 Facilities completed
Waikato
Bay of Plenty
5
3
1
1
• 1 Facility in Progress Midland
Lakes 2 1
• 31 Remaining Tairawhiti 1 0
Taranaki 2 1
Capital and Coast 2 1
Hutt Valley 1 0
Wairarapa 1 0
Central
Mid-Central 2 0
Whanganui 1 0
Hawkes Bay 1 0
Nelson Malborough 3 0
Canterbury 3 0
Southern
West Coast 1 0
South Canterbury 1 0
Southern District 3 0
TOTAL 40 8

22. 100% Engagement
 Data collection strategies tailored to meet each hospital’s
needs
 Strategies include:
• online survey
• phone interview
• Excel spreadsheets, etc.
 Support provided by HIMSS Analytics Asia Pac research
team
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23. Benefits of Participation
 Creates a common language for discussing IT strategy at
the facility, district, national and regional levels
 Identifies best practices and opportunities for improved
clinical, financial, and operational outcomes
 Validates and informs IT Investment and strategy
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24. THANK YOU!
Gary Lakin, Regional Director
HIMSS Analytics Asia Pacific
glakin@himss.org

25. Appendix
 HIMSS Analytics Stage 7 Awards recipients:
http://www.himssanalyticsasia.org/emram/stage7hospitals.asp
 HIMSS Analytics Stage 7 Case Studies:
http://www.himssanalyticsasia.org/emram/stage7caseStudySNUBH.asp
 HIMSS Analytics Stage 6 Awards recipients:
http://www.himssanalyticsasia.org/emram/stage6hospitals.asp
 HIMSS Analytics Benchmark Reports:
http://www.himssanalyticsasia.org/market/benchmarkingReports.asp
 HIMSS Analytics FAQ:
http://www.himssanalyticsasia.org/market/FAQ.asp
 Contact:
Gary Lakin, Country Lead
E: glakin@himss.org
M: 0400 808 504
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